International Orthopaedics

, Volume 42, Issue 5, pp 1143–1147 | Cite as

Pelvic pyomyositis in children: changing trends in occurrence and management

  • Manish Kiran
  • Saffwan Mohamed
  • Ashley Newton
  • Harvey George
  • Neeraj Garg
  • Colin Bruce
Original Paper



We present the largest series of paediatric pelvic pyomyositis from a temperate country, analyse the factors influencing long term prognosis and suggest a diagnostic protocol.

Materials and method

We included 41 patients diagnosed with primary paediatric pelvic pyomyositis between 1998 and 2016, in this study with a mean age of 7.5 years. Demographic, clinical, radiological and follow-up data were reviewed. Statistical analysis was performed to analyse the influence of early diagnosis and treatment on the final outcome.


There was an increased occurrence of primary pelvic pyomyositis in the last two years. Of cases identified, 85% fulfilled Kocher’s criteria for hip septic arthritis. The mean time to diagnosis was 2.8 ± 0.8 days. The most common muscle affected was obturator internus (65.85%) and multifocal involvement was common (46.34%). Early diagnosis and antibiotic treatment within seven days from the time of onset of symptoms was the only factor that influenced final outcome (p < 0.001).

Discussion and conclusion

Pyomyositis is no longer restricted to tropical countries. The time from onset of symptoms to start of antibiotic treatment influences the final outcome. Clinical examination and inflammatory markers have low specificity in distinguishing between pyomyositis, septic arthritis, osteomyelitis or other infections. MRI is more sensitive and can diagnose pyomyositis in its early stages. Every suspected case of septic arthritis of the hip should undergo an ultrasound. MRI scan may be performed if the ultrasound shows inconclusive evidence of an effusion. Early identification will facilitate early antibiotic treatment which will improve the final outcome.

Clinical relevance

There is an increasing occurrence of this tropical disease in temperate countries. Early diagnosis with an MRI scan and early antibiotic use results in good outcomes.


Pyomyositis Pelvic Infection Septic arthritis 



No funding was given to any of the authors.

Compliance with ethical standards

Conflict of interest

None of the authors have any conflict of interest.


  1. 1.
    Unnikrishnan PN, Perry DC, George H, Bassi R, Bruce CE (2010) Tropical primary pyomyositis in children of the UK: an emerging medical challenge. Int Orthop 34(1):109–113CrossRefPubMedGoogle Scholar
  2. 2.
    Chattopadhyay B, Mukhopadhyay M, Chatterjee A, Biswas PK, Chatterjee N, Debnath NB (2013) Tropical pyomyositis. N Am J Med Sci 5(10):600–603CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Crum NF (2004) Bacterial pyomyositis in the United States. Am J Med 117(6):420–428CrossRefPubMedGoogle Scholar
  4. 4.
    Moriarty P, Leung C, Walsh M, Nourse C (2015) Increasing pyomyositis presentations among children in Queensland, Australia. Pediatr Infect Dis J 34(1):1–4CrossRefPubMedGoogle Scholar
  5. 5.
    Brown JD, Wheeler B (1984) Pyomyositis. Report of 18 cases in Hawaii. Arch Intern Med 144(9):1749–1751CrossRefPubMedGoogle Scholar
  6. 6.
    Adams S, Petz C (2015) Tropical pyomyositis in a temperate climate. J S C Med Assoc 111(4):137–138PubMedGoogle Scholar
  7. 7.
    Verma S (2016) Pyomyositis in children. Curr Infect Dis Rep 18(4):12CrossRefPubMedGoogle Scholar
  8. 8.
    Verma S, Singhi SC, Marwaha RK, Singhi P, Singh S, Singh M (2013) Tropical pyomyositis in children: 10 years experience of a tertiary care hospital in northern India. J Trop Pediatr 59(3):243–245CrossRefPubMedGoogle Scholar
  9. 9.
    Horn CV, Master S (1968) Pyomyositis tropicans in Uganda. East Afr Med J 45(7):463–471PubMedGoogle Scholar
  10. 10.
    Chiedozi LC (1979) Pyomyositis. Review of 205 cases in 112 patients. Am J Surg 137(2):255–259CrossRefPubMedGoogle Scholar
  11. 11.
    Kocher MS, Zurakowski D, Kasser JR (1999) Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence- based clinical prediction algorithm. J Bone Joint Surg Am 81(12):1662–1670CrossRefPubMedGoogle Scholar
  12. 12.
    Bertrand SL, Lincoln ED, Prohaska MG (2011) Primary pyomyositis of the pelvis in children: a retrospective review of 8 cases. Orthopedics 34(12):e832–e840PubMedGoogle Scholar
  13. 13.
    Pannaraj PS, Hulten KG, Gonzalez BE, Mason EO Jr, Kaplan SL (2006) Infective pyomyositis and myositis in children in the era of community- acquired, methicillin-resistant Staphylococcus aureus infection. Clin Infect Dis 43(8):953–960CrossRefPubMedGoogle Scholar
  14. 14.
    Gubbay AJ, Isaacs D (2000) Pyomyositis in children. Pediatr Infect Dis J 19(10):1009–1012CrossRefPubMedGoogle Scholar
  15. 15.
    Mitsionis GI, Manoudis GN, Lykissas MG, Sionti I, Motsis E, Georgoulis AD, Berisa AE (2009) Pyomyositis in children: early diagnosis and treatment. J Pediatr Surg 44(11):2173–2178CrossRefPubMedGoogle Scholar
  16. 16.
    Ghazala CG, Fatone E, Bentley R, Rajeev A (2016) Primary bacterial gluteal pyomyositis: a rare disease in temperate climates presenting as suspected septic arthritis of the hip. J Emerg Med 51(3):319–321CrossRefPubMedGoogle Scholar
  17. 17.
    Park E, Chilstrom M (2016) Diagnosis of pyomyositis in a pediatric patient with point-of-care ultrasound. West J Emerg Med 17(4):464–465CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Plumb J, Mallin M, Bolte RG (2015) The role of ultrasound in the emergency department evaluation of the acutely painful pediatric hip. Pediatr Emerg Care 31(1):54–58CrossRefPubMedGoogle Scholar
  19. 19.
    Tharmarajah H, Marks M (2015) Early use of MRI for suspected pyomyositis. J Paediatr Child Health 51(6):651–652CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2017

Authors and Affiliations

  • Manish Kiran
    • 1
  • Saffwan Mohamed
    • 1
  • Ashley Newton
    • 1
  • Harvey George
    • 1
  • Neeraj Garg
    • 1
  • Colin Bruce
    • 1
  1. 1.Department of Trauma and Orthopaedic SurgeryAlder Hey Children’s HospitalLiverpoolUK

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